Provider Demographics
NPI:1780961904
Name:ANTHONY M. CARUSO, DC, PC
Entity type:Organization
Organization Name:ANTHONY M. CARUSO, DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-832-8888
Mailing Address - Street 1:2577 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-9411
Mailing Address - Country:US
Mailing Address - Phone:716-832-8888
Mailing Address - Fax:716-832-0124
Practice Address - Street 1:2577 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-9411
Practice Address - Country:US
Practice Address - Phone:716-832-8888
Practice Address - Fax:716-832-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2012-08-17
Deactivation Date:2011-12-21
Deactivation Code:
Reactivation Date:2012-08-17
Provider Licenses
StateLicense IDTaxonomies
NYX005751111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty